Healthcare Provider Details

I. General information

NPI: 1013763499
Provider Name (Legal Business Name): THERAPY BY ADRIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 W DURHAM ST
KILL DEVIL HILLS NC
27948-8276
US

IV. Provider business mailing address

703 W DURHAM ST
KILL DEVIL HILLS NC
27948-8276
US

V. Phone/Fax

Practice location:
  • Phone: 252-202-3992
  • Fax: 252-417-7982
Mailing address:
  • Phone: 252-202-3992
  • Fax: 252-417-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA CRISTINA GOMEZ-NICHOLS
Title or Position: OWNER
Credential: LCMHC
Phone: 919-297-8175